肌骨超声与X线片诊断青少年胫骨结节软骨炎的比较  

Comparative diagnostic value of musculoskeletal ultrasound and X-ray examination in adolescents with Osgood-Schlatter disease

作　　者：叶萍萍 段红波[1] 邵国庆[1] 刘珊珊 方士波 赵华国[2] YE Pingping;DUAN Hongbo;SHAO Guoqing;LIU Shanshan;FANG Shibo;ZHAO Huaguo(Department of Ultrasound,Ningbo No.6 Hospital,Ningbo,Zhejiang 315040,China;不详)

机构地区：[1]宁波市第六医院超声科,浙江315040 [2]宁波市第六医院骨科,浙江315040

出　　处：《中国骨与关节损伤杂志》2024年第10期1039-1043,共5页Chinese Journal of Bone and Joint Injury

摘　　要：目的比较肌骨超声与X线片诊断青少年胫骨结节骨软骨炎的效能,分析此类患者的超声声像图表现。方法纳入自2020-01—2022-12因膝关节胫骨结节处疼痛而就诊的99例青少年患者,由高年资骨外科医师根据临床诊断标准、肌骨超声图像、X线片图像明确诊断结果。比较肌骨超声及X线片诊断胫骨结节骨软骨炎的诊断效能,包括漏诊率、误诊率、灵敏度、特异度、准确度、阳性预测值、阴性预测值。结果99例中确诊78例胫骨结节骨软骨炎,21例不是胫骨结节骨软骨炎(胫骨结节处皮下软组织挫伤6例,髌腱损伤6例,皮下积液4例,髌下浅囊积液2例,软组织内血肿2例,胫骨结节骨折1例)。肌骨超声诊断胫骨结节骨软骨炎的灵敏度、特异度、准确度、阳性预测值、阴性预测值高于X线片诊断,而漏诊率、误诊率低于X线片诊断,差异有统计学意义(P<0.05)。胫骨结节骨软骨炎患者的超声声像图表现包括以下一种或几种:①胫骨结节前软骨肿胀,表现为低回声软骨厚度增加;②皮下软组织肿胀,表现为皮下软组织增厚,回声偏强不均;③髌腱下止点肿胀,表现为纵切时髌腱远端增厚,回声减低;④胫骨结节次级骨化中心碎裂,表现为骨化中心连续性中断,呈多个强回声;⑤髌下滑囊积液,表现为髌腱下方内侧探及液性暗区;⑥彩色多普勒显示髌腱下止点探及血流信号,胫骨结节软骨处探及血流信号。结论肌骨超声诊断青少年胫骨结节骨软骨炎的效能高于X线片,肌骨超声联合彩色多普勒超声可以发现明显特异性征象,进而有效明确病变情况。Objective To compare the diagnostic efficacy of musculoskeletal ultrasound and X-ray in adolescents with Os⁃good-Schlatter disease and analyze the ultrasonographic findings of such patients.Methods Ninety-nine adolescent patients who sought medical attention due to pain at the tibial tuberosity of the knee from January 2020 to December 2022 were included.A senior orthopedic surgeon confirmed the diagnosis based on clinical diagnostic criteria,musculoskeletal ultrasound images and X-ray images.The diagnostic efficacy of musculoskeletal ultrasoundand X-ray was compared in terms of missed diagnosis rate,misdiagnosis rate,sensitivity,specificity,accuracy,positive predictive value and negative predictive value.Re⁃sults Among the 99 cases,78 were confirmed to have Osgood-Schlatter disease,while 21 cases were not(including 6 cases of subcutaneous soft tissue contusion at the tibial tuberosity,6 cases of patellar tendon injury,4 cases of subcutaneous effusion,2 cases of infrapatellar bursa effusion,2 cases of soft tissue hematoma,and 1 case of tibial tuberosity fracture).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of musculoskeletal ultrasound were higher than those of X-ray,but with lower missed diagnosis rate and misdiagnosis rate.The differences were statistically significant(P<0.05).Patients with Osgood-Schlatter disease presented with one or more of the following ultrasonographic findings:swelling of the anterior cartilage of tibial tuberosity,characterized by increased thickness of the cartilage with low echogenicity;swelling of subcutaneous softtissues,characterized by thickened and uneven echogenic subcutaneous tissues;swelling at the lower insertion of the patellar tendon,characterized by the thickening of distal patellar tendon with reduced echogenicity in the longitudinal sec⁃tion;fragmentation of the secondary ossification center of tibial tuberosity,characterized by discontinuity in the ossification cen⁃ter with multiple strong echoes;effusion in the i

关 键 词：胫骨结节骨软骨炎 肌骨超声 X线片 诊断效能 青少年 

分 类 号：R681.4[医药卫生—骨科学]